![]() ![]() 4C), with good angiographic results ( Fig. Then, with use of a GuideLiner catheter, we selectively catheterized the anomalous LMCA and deployed a drug-eluting stent in the stenotic ostial LAD ( Fig. We treated the stenosis in the mid RCA by implanting 2 drug-eluting stents. A coronary angiogram obtained with use of a Judkins right catheter through the right femoral artery revealed severe stenosis of the posterior descending coronary artery and mid RCA and stenosis of the ostial LAD ( Fig. The cardiac CT angiogram also revealed severe stenosis in the mid RCA and ostial LAD. At presentation, a 320-slice cardiac CT angiogram revealed anomalous origin of the LMCA from an ostium shared with the RCA at the right sinus of Valsalva, with an intraseptal course (L-ACAOS-IS) ( Fig. Single-photon emission CT myocardial perfusion images obtained before presentation had shown severe ischemia in the anterior and inferior cardiac segments. She remained asymptomatic one year later.Ī 68-year-old man with a history of smoking and high blood pressure presented with progressive chest pain of 4 months' duration. Five days after PCI, the patient had recovered atrioventricular conduction and was discharged from the hospital. The total procedure time was 100 minutes. Finally, we implanted a drug-eluting stent, which restored distal flow ( Fig. ![]() 3A), so we advanced a Guide-Liner catheter over an anchoring balloon to selectively catheterize the artery and cross the lesion ( Fig. The proximal RCA was completely occluded ( Fig. ![]() Then, we advanced the extra backup guide catheter to the ostium of the RCA that originated from the left coronary sinus (R-ACAOS), near the left main coronary artery (LMCA). First, we implanted 2 overlapping stents from the proximal to the mid LAD to improve retrograde flow to the inferior segments. We then decided to perform rescue PCI with use of a 3.5 extra backup guide catheter. Several unsuccessful attempts were made to locate the RCA with use of 5F Judkins right, 6F Amplatz right, and 6F Amplatz left catheters orthogonal aortography and angiographic exploration of the 3 aortic sinuses through the femoral artery. A left coronary angiogram obtained through the right radial artery revealed extensive stenosis of the mid left anterior descending coronary artery (LAD) and collateral circulation to the distal RCA from septal branches. The patient was discharged from the hospital one day after the stenting procedure and remained asymptomatic one year later.Ī 71-year-old woman presented with syncope and complete atrioventricular block associated with acute inferior myocardial infarction (MI) of one hour's duration. Finally, 2 overlapping stents were deployed at the proximal and mid RCA with good angiographic results ( Fig. A GuideLiner catheter was deployed to selectively catheterize the artery. A Judkins 3.5 left guide catheter was inserted through the right radial artery and advanced until it engaged the RCA. Given the low risk of this subtype of R-ACAOS with a course below the pulmonary artery and aorta compression plane, we decided to perform PCI. The stress MRI scan showed ischemia of the inferior wall, and the cardiac CT angiogram revealed R-ACAOS with a low interarterial course below the valve plane and severe stenosis at the mid RCA. Two weeks before presentation, the patient had undergone stress magnetic resonance imaging (MRI) and multislice cardiac computed tomographic (CT) angiography. The patient was discharged from the hospital 3 days later with normal systolic left ventricular function, and she remained asymptomatic 1.5 years later.Ī 68-year-old man with one kidney and effort angina presented for coronary angiography. Finally, 2 overlapping drug-eluting stents were deployed at the mid and proximal RCA, resulting in Thrombolysis In Myocardial Infarction (TIMI)-3 flow and relief of chest pain ( Fig. An aspiration catheter was then advanced through the occluded segment with use of a GuideLiner catheter to provide backup support and selectively catheterize the vessel. An Amplatz left 1.0 guide catheter was inserted and advanced to engage the RCA ostium, followed by a Balance Middleweight wire however, distal flow was not restored. A subsequent aortogram revealed complete occlusion of an anomalous RCA originating from the left coronary sinus (R-ACAOS). An urgent coronary angiogram obtained through the right radial artery revealed a regular left coronary artery tree however, the right coronary artery (RCA) could not be located despite the use of several different catheters (Judkins right 4.0, Amplatz right 2.0, and Judkins left 3.5). An electrocardiogram obtained at presentation showed ST-segment elevation in the inferior leads. A 52-year-old-woman with no known cardiovascular risk factors presented with acute chest pain of one hour's duration. ![]()
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